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Why do patients complain?

29 April 2021

Many doctors will experience a complaint, investigation or clinical negligence claim during their medical career; some of these concerns could come from a patient, an employer or via the Medical Council and could relate to any aspect of professional practice. Complaints against doctors have unfortunately become more common in recent years. This is likely due to the increasing complexity of medicine and an emerging complaints culture amongst the general public, rather than any decrease in doctors’ performance.

Patients can make a complaint about any aspect of the medical care they receive. Some common reasons for patient complaints include:

• Incorrect, missed or delayed diagnosis

• Delayed treatment

• Post-surgery complications

• Poor explanation of their options

• Inappropriate conduct or behaviour of the doctor

• Lack of informed consent (or capacity to consent)

• Breach of patient confidentiality

The list is not exhaustive – there are many examples of what can go wrong in a clinical setting. Doctors are, after all, only human and errors can occur despite their best efforts, particularly when they are working under pressure in a stressful environment.

What can happen following a complaint?
A patient complaint, or clinical incident involving a patient, can lead to many different types of investigation, for example:

• Complaint directly to the provider (eg hospital or GP practice)

• Medical Council investigation

• Hospital inquiry (eg serious adverse incident inquiry)

• An inquest if a patient has died

• Disciplinary action by the employer 

• Negligence claim (for financial compensation)

• Criminal investigation

We encourage our members to contact us as soon as an incident occurs, so that we can offer advice on what to do next. Early intervention is key and can sometimes prevent an incident escalating into one or more of the other investigations listed above. 

What risks might I face as a medical student?
Although not yet qualified, students can still be the subject of a complaint and may find themselves facing a complaint investigation for various reasons including: 

• Misconduct on social media

• Clinical mistakes, or poor communication, when working with patients

• Accusations of poor practice during an elective

If you’re worried about any current or potential issues, you can email us or call our dedicated student support and advice line on 0800 952 0442.

What risks might I face as a junior doctor?
Once you qualify, you face multiple occupational risks that could unfortunately have grave consequences for your career, reputation and finances. 

Above we covered some of the main reasons why patients complain and the various consequences that can arise from a complaint. However, the specific risks you may face will depend on what type of doctor you become and where you work. 

The nature, quantity and severity of complaints also varies by specialty. Did you know, for example, that obstetricians are more likely to face high-value clinical negligence claims? 

This may all sound incredibly daunting, but help is available; medical defence organisations like Medical Protection exist to support doctors in such situations.

How can I avoid patient complaints and other medicolegal problems?
“Prevention is better than cure”. It's a well-known phrase in medicine, and it’s also true where medicolegal issues are concerned. 

You can help protect yourself from future complaints and claims by being aware of potential risks and taking steps to mitigate these before an incident occurs. Most patient complaints relate to one or more of the following areas:

• Competence

• Communication

• Consent

• Confidentiality

• Conduct

Being aware and knowledgeable about potential risk will have a positive impact on your behaviour and clinical performance. Here are our suggestions:

Stay up to date 
Keep abreast of the latest developments in healthcare, such as news, policy announcements and important changes to regulations and legislation.

Work on your ‘soft’ skills 
Are your organisational skills up to scratch? It is common for medicolegal cases to involve poor record-keeping.

Do you communicate effectively? Patients will usually appreciate honest, open doctors who communicate effectively, explain issues clearly and apologise appropriately when things don’t go to plan.

It’s also key that you communicate clearly and fully with colleagues at all levels. For more advice on this, including tips for managing successful handovers, see: Surviving Medical School: Communication between colleagues

Learn from others’ mistakes 
Many doctors have found themselves in tricky situations; learn from them so you don’t end up in the same position. Read our case reports here.

Take online courses
Medical school doesn’t cover everything. If time allows, take additional online courses. 

Members can access this content by logging into PRISM. Helping members to avoid problems before they happen is central to our approach, so we provide a wide range of educational resources and workshops covering areas such as:

• Medicolegal issues

• Professionalism and ethics

• Communication and interpersonal skills

• Systems and processes

• Clinical risk management

What if I make a mistake?
Sometimes prevention isn’t enough and even the best, most diligent doctors find themselves facing complaints and legal action. At this stage there are still steps you can take to protect yourself.

Recognise and report early
Contact your medical defence organisation as soon as possible. We encourage members to contact us as soon as an incident occurs, as we may be able to prevent it from escalating to a more serious problem. Our medicolegal consultants have extensive experience with a wide range of issues – major and minor – and they can advise you on what to do next.

Rectify the mistake and prevent further harm
Take responsibility for what’s happened and do what you can to rectify the situation. You can’t undo the mistake entirely, but you may be able to prevent the patient coming to any further harm.

The Medical Council provides guidance for doctors in Guide to Professional Conduct and Ethics for Registered Medical Practitioners (amended) 8th edition. 2019: "If an adverse event occurs, you should make sure its effects on the patient are minimised as far as possible. If the patient needs further care because of the adverse event, you should make sure they are helped and supported through this process."

Speak to the patient and family
Be honest. Listen and respond to their concerns.

The Medical Council expects all doctors to have a duty of candour towards their patients and states: "Patients and their families, where appropriate, are entitled to honest, open and prompt communication about adverse events that may have caused them harm. When discussing events with patients and their families, you should:

• acknowledge that the event happened

• explain how it happened

• apologise, if appropriate

• assure patients and their families that the cause of the event will be investigated and efforts made to reduce the chance of it happening again."

Learn from mistakes
Resilience and continuous development are part and parcel of being a great doctor. Use negative experiences as learning opportunities and take steps to ensure the same errors are not made again. Did the experience highlight problems in the wider team, such as poor communication or inadequate administrative processes? If so, raise these with a more senior colleague to minimise the chance of a repeat issue.

The Medical Council advises doctors: “If you are involved in an adverse event, you should report it, learn from it and take part in any review of the incident.”

How Medical Protection can help

Receiving a complaint or claim is incredibly difficult for any medical practitioner. Alongside the inevitable emotional stress, doctors could find themselves facing financial penalties, reputational damage and potentially withdrawal of their right to practise medicine.

When such incidents occur, members of Medical Protection should contact us so we can provide expert advice and support.

However, we’re not just there when things go wrong – members can contact us at any time for advice on risk mitigation and professional ethical dilemmas. 

We also help all our members proactively reduce their risk of facing medicolegal issues by giving them access to a wide range of educational resources like articles, case studies, events and webinars. 

If you need advice at any time, don’t hesitate to contact us for support and advice.